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Thread: Positive margins and PSA

  1. #1

    Positive margins and PSA

    My dad had his prostate removed 10/5. His Gleason was a 7 (4+3). PSA 7.1.

    All pathology came back negative no lymph node or other organ invasion but came back with positive surgical margins and T2C.

    Does this mean it metastasized? His first post op PSA came back less than 0.01.

    His doctor is not all the concerned , he will start radiation as soon as he gains control of his bladder, he has started hormone therapy though.

    My question is about whether it has metastasized or not and if that PSA post op means anything

    Thanks for any insight!

  2. #2
    Top User lancepeace's Avatar
    Join Date
    Apr 2011
    Cleveland, Ohio
    Welcome. I think the radiation and hormone therapy are to try to nip any spread in the bud, so to speak. They are probably just suspecting spread to justify these additional treatments.
    The PSA result is a definite plus for him.
    If there were spread, the radiation would probably kill or control it for many, many years.
    They can not be sure about metastasis, some of which can be microscopic and take many years to reappear. He will probably live a long time in any case. Good luck.
    DOB Sept. 1947. Prostate cancer Gleason 7 (3+4), PSA 5 in Oct 2010. Cryoablation Jan. 2011. Had some complications.
    Experienced nocturia, irritable bladder summer 2011. "Agent Orange"compensation from VA Oct 2011.
    PSA: .05 01/26/2012, .06 6/26/2012, .04 12/24/2012, .04 6/26/13, .05 1/27/14, .05 10/21/14, .04 10/15
    I am eating vegan mostly plus a little fish. Take some supplements.
    (Any advice given is the personal opinion of a layman and is not intended to replace the advice of a health professional.)

  3. #3
    Top User
    Join Date
    Aug 2010
    Southern California
    Quote Originally Posted by rooster0330 View Post
    Does this mean it metastasized? His first post op PSA came back less than 0.01.

    His doctor is not all the concerned , he will start radiation as soon as he gains control of his bladder, he has started hormone therapy though.

    My question is about whether it has metastasized or not and if that PSA post op means anything

    Welcome. The good news is based on his post op pathology (though a little skimpy from your post) and PSA, most likely he has localized, organ confined prostate cancer. The only negative is his surgeon left a little behind hence the "positive margins". Quite often, the act of surgery will kill those cancer cells that were left behind (according to Dr. Walsh's book). As lancepeace said, his doctor wanted to start adjuvant radiation and hormone to ensure that nothing is left to chances. However, not all oncologists agree that adjuvant radiation/hormone is the way to go in this case when the post op PSA is undetectable. It is worthwhile for your dad to seek a second opinion.

    If you like, you can post a more detail write up of his pathology report as there maybe some other factors that caused his doctor to want to start adjuvant treatments, also so that some others can make additional comments and share their experiences.

    Good luck.
    PCa Dx 2010 at 65. PSA increased from 2.5 in 2000 to 10.7 in 2010. Four biopsies in 6 years. Final biopsy in 2010: 1 of 12 cores 5% cancer, G6
    CT, bone scans & MRI all negative
    Da Vinci 8/10; nerve sparing, catheter out in 7 days; no incontinence, no ED
    Post Op Pathology pT2N0Mx: organ confined; negative margins; lymph nodes & seminal vesicle not involved but PNI present; cancer extensive within prostate, multifocal G 3+3 and tertiary G 4
    Infected lymphocele diagnosed and treated in 2014, 4 yrs after RALP
    PSA <.1 for the past 6 years.

  4. #4
    Top User FeatherBoy's Avatar
    Join Date
    Sep 2012
    Phoenix, AZ
    Hi rooster,
    I agree with the others in that it would be helpful to have additional pathology information.
    Positive margins DO NOT automatically mean metastases. However, if untreated, it is possible that they might contribute to it years down the road.
    His G7 (4+3) is moderately aggressive and adjuvant radiation to the prostatic fossa (bed) is commonly used in cases like this with excellent results and generally few side affects.
    In fact, I'm currently going through it myself.
    I AM curious about why they decided to include hormone therapy along with the radiation with such a low PSA. To me, it seems like overkill because hormone therapy in one of your "big guns" that you generally reserve for later, if and when you need it.
    In any case, I'm sure your father will have many more years to enjoy symptom free.
    Good luck! --- Dave
    Age At Diagnosis: 59
    Pre-Op PSA: 4.5
    Diagnosis: Prostatic Adenocarcinoma
    Surgery: Retropubic Radical Prostatectomy (RRP) 07/16/2012
    Stage: pT2c,pNO,PMX
    Gleason Grade: 4+3=7 (Not-So-Good Cancer)
    Extraprostatic Extension: Neg.
    Lymph Nodes: Neg.
    Seminal Vesicles: Neg.
    Positive Margins
    Tumor Quantitation: <5% Of Prostate
    Tumor size: 1.1cm.
    High-Grade PIN
    Perineural Invasion: Present
    Post-Op PSA: 0.4
    Completed 35 sessions adjuvant IMRT on 12/13/2012
    PSA as of 01/10/2013: 0.2
    PSA as of 04/12/2013: 0.1
    PSA as of 07/10/2013: <0.1
    PSA as of 10/08/2013: 0.1
    PSA as of 01/15/2014: 0.2
    Still holding at 0.2 7/15
    0.3 as of 12 month ago.
    0.8 as of 9 months ago.
    1.8 as of 6months ago.
    1.6 as of 3 months ago
    7.3 as of 05/15/2017
    Bone Scan 06/08/2017 Negative
    9.3 as of 06/14/2017

    'Archaeologist of The Forum Archives'

    "Every day above ground is a good day". -- Scarface

  5. #5
    I don't have access to the pathology report although like I stated it was graded a t2C and no invasion of anything no lymph nodes, or anything only positive margins

    His dr said he always does the hormone with the radiation for positive margins!!! He said he has no doubt that my dad will live the next 40 years!!! That would make him 110 lol!!!


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